The epidemiology and management of spontaneous spinal epidural abscesses in children: a single-center experience.

Objective: Spinal epidural abscesses (SEAs) are rare infections in children but can lead to significant neurological sequelae. The authors sought to describe the presentation, management, and outcomes of children with these infections at their institution.

Methods: This was a retrospective study of pediatric patients admitted with SEA to a quaternary children's hospital between 2013 and 2023. Clinical characteristics including laboratory, surgical, and antimicrobial data were collected and analyzed.

Results: Fourteen patients (median age 3.7 years) had SEAs. Thirteen (93%) patients developed the infection in the outpatient setting, and of these 10 (77%) were evaluated by a medical provider prior to the encounter when the diagnosis was made. The most common causative pathogen was Staphylococcus aureus. Thirteen (93%) of 14 patients underwent a surgical procedure, and patients were treated with antibiotics for a median of 38 days. Eleven (79%) of 14 patients received enteral antibiotics for part of their treatment course. All patients recovered with no neurological sequelae.

Conclusions: SEAs are rare infections, but good outcomes can be obtained with prompt antimicrobial and surgical management. Enteral antibiotics should be considered as part of therapy. Larger multicenter studies are needed to determine the optimal antibiotic duration and route, and which patients should undergo neurosurgical intervention versus interventional radiology drainage or medical management alone.